Cuban Medical Schools Turn Out Top-notch Doctors, Health Experts Say

How good is a Cuban medical education? If the world's public health experts are to be believed, a medical degree from President Fidel Castro's small island nation can hang proudly next to diplomas from Harvard or Stanford.

Especially in the field of global public health, Cuban-educated doctors draw raves around the world. Many are the thin health line between contagions such as cholera and desperately poor populations in the Caribbean, South America and Africa.

Cubans have propped up a collapsed health system in Haiti, provided field care in hurricane-ravaged Honduras, and prompted a much-lauded AIDS prevention campaign in Uganda.

After cigars and rum, one might say medical care is the country's leading export. In recent years, Cuba has sent an estimated 20,000 doctors abroad to work in rural areas throughout Africa and Latin America.

That has bought Castro valuable friends among leaders in developing regions such as Central America and sub-Saharan Africa. Building on a medical establishment that was well-regarded before he came to power, Castro has used medical care in much the way the United States buys friends through programs such as USAID.

"I wouldn't hesitate to work with a doctor educated there,'' said Dr. Anthony Kirkpatrick, a professor at the University of South Florida College of Medicine who has worked extensively in Cuba.

"In fact, these students who go to school there are going to learn something they can't learn in the United States, and that's how to get the best outcomes with the least amount of resources.''

Not every one is impressed. Exile leaders claim Cuba's medical reputation is vastly overrated, a propaganda tool bandied by leftist sympathizers in the United States and around the world. They point to several recent examples of Cuban doctors attempting to flee assignments in Africa, where they're often forced to work in dangerous conditions.

Joe Garcia, the executive director of the Cuban American National Foundation, ridiculed the notion that the U.S. students soon to be educated in Cuba would ever be able to practice medicine in the United States. Foreign-trained doctors, many Cuban, never get a chance to practice medicine in this country because they are unable to pass the required exams, he said.

``Now we're going to send eight more," Garcia said.

Garcia said the Cuban doctors working around the world are nothing but slaves of the Castro government.

"These are not people that do it out of dedication. These are people that are ordered to do it," he said.

But many doctors who work in international health point to Cuba's vital statistics. It has one of the lowest infant mortality rates in Latin America, and has managed to curtail the spread of the AIDS epidemic hitting other Caribbean countries.

Thanks to aggressive vaccination campaigns, Cuba has eradicated a large number of common diseases, including measles, mumps, polio, diphtheria and tuberculosis. Life expectancy has remained at 75 years -- one year lower than in the United States.

"In many cases, they've actually built a better mousetrap in terms of medical care," said Kirkpatrick, a specialist in anesthesiology and an outspoken critic of the U.S. embargo of Cuba. "And they do it by learning to save resources. Here students learn to waste resources."

A Cuban medical education is far ahead of the much-maligned Caribbean medical schools often attended by U.S. students whose grades are not up to snuff.

Some aspects of Cuban medical care are highly advanced. Surgeons at the Ameijeiras Brothers Hospital, for example have performed numerous heart transplants in the past 10 years. Researchers have done pioneering vaccine research for meningitis C and cholera, and U.N. experts say Cuba has the capability to cheaply copy expensive AIDS drugs.

As an example, Kirkpatrick cited a novel approach the Cubans have developed that places intensive care units in hospitals next to surgery wings. In U.S. hospitals, ICUs are often located well away from surgery area, often on separate floors.

"One of the high-risk times is when you have to move a patient from intensive care back to surgery,'' Kirkpatrick said. "By combining the two areas, they provide safer and more effective care."

In the past four decades Cuba has been isolated by the U.S. embargo and diplomatically tied to often poor communist and Third World nations. The country lost thousands of doctors after Castro came to power and was forced to radically modify a top-notch medical program for Third World conditions.

The result is an expertise at what might be called global triage: adapting quickly and efficiently to conditions where there's little equipment and even less medicine. A Cuban, for instance, likely wouldn't blink at tetanus, a deadly killer of children that is rarely ever seen in the United States but common in the Third World.